Background to this inspection
Updated
17 August 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 14 June 2018 and was unannounced. The inspection was completed by one adult social care inspector and an expert by experience. An expert by experience is
someone who has had direct experience or their relative had used registered services such as care homes.
The provider had completed a Provider Information Return (PIR). This is a form we ask the provider to complete at least once a year. It gives us some key information about the service, what the service does well and improvements they plan to make. We looked at other information we held about the service. This included previous inspection reports and notifications. Notifications are changes, events or incidents that the service must inform us about. We contacted the local authority commissioning team, who has responsibility for monitoring the quality and safety of the service provided to local authority funded people. We received feedback from two health care professionals about their experiences of the service provided.
During the inspection we spoke with four people. However, some other people were not able to comment specifically about their care experiences, so we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people living with dementia. We also spoke with two relatives, nine staff including the cook, administrator, care staff, maintenance person, quality assurance lead, regional operations manager and the registered manager.
We looked at three peoples care files including risk assessments, care plans and daily records. We reviewed three medicines records, three recruitment records and a variety of records relating to the auditing of the environment and quality of care.
Updated
17 August 2018
This comprehensive inspection was unannounced and took place on 14 June 2018. At the previous comprehensive inspection completed in June 2016 we rated the service as overall Good with outstanding in caring domain. It this inspection we found the rating remained the same.
Lawrence House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The care service has not been developed and designed in line with the values that underpin the Registering the Right Support because it is registered for more than six people. However, it does follow best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities using the service can live as ordinary a life as any citizen.
The registered manager is also the registered owner. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
People said they felt safe and well cared for. The service remains outstanding in caring because staff were always willing to go the extra mile to ensure people had fulfilling lives. Staff came in on their own time for support to enable people to go out and about. Staff were also extremely skilled at understanding people’s unique ways of communicating. This helped to ensure their well-being was maintained and that they were fully involved in making choices where possible.
There were sufficient staff with the right skills and understanding of people’s needs and wishes. This meant outcomes for people had improved. People said staff were kind and helpful. Our observations showed staff respected people’s dignity and privacy and worked in a way which showed kindness and compassion.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People's consent to care and treatment was sought. Staff used the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and understood how these applied to their practice.
Care and support was person centred and well planned. Staff had good training and support to do their job safely and effectively. Activities were tailored to meet individual’s needs. Some people had additional funding to allow one to one staff support for them to access the community.
Risk assessments were in place for each person. These identified the correct action to take to reduce the risk as much as possible in the least restrictive way. People received their medicines safely and on time most of the time. There was a high number of medicine errors. An action place had been developed to ensure staff had further training and to reduce the number of errors. Accidents and incidents were carefully monitored, analysed and reported upon.
Prior to this inspection we received some information of concern which stated recruitment practices did not include all the necessary checks. During this inspection we found no evidence to support this. There were effective staff recruitment and selection processes in place. People received the right care and support from staff who were well trained and competent.
People enjoyed a wide and varied choice of meals. Mealtimes were relaxed and enjoyable for people.
Quality assurance processes and audits helped to ensure that the quality of care and support as well as the environment was closely monitored. This included seeking the views of people and their relatives.